Functional outcomes after surgery for spinal fractures: return to work and activity

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Spinal cord injury research

Background:

• Limited data exists on the functional impact of surgical treatment for spinal fractures.
• Concerns include operative injury effects on muscle, motion segments, and instrumentation.
• Nonoperative care shows variable, hard-to-reproduce results with poorly documented functional outcomes.

Purpose of the Study:

• To report return to work and functional recovery in severely injured patients treated with segmental spinal instrumentation.
• To assess outcomes at a 5-year follow-up.

Main Methods:

• Seventy consecutive patients with unstable thoracic, thoracolumbar, and lumbar spine fractures treated with Cotrel Dubousset instrumentation were followed.
• Patients had high-energy trauma, with 38% polytraumatized and 56% with neurologic injuries.
• Functional recovery assessed via return to work, work level, and daily activity at a mean 5-year follow-up (n=62).

Main Results:

• 70% of patients returned to full-time work; 8% were capable of lighter work.
• 54% returned to previous employment without restrictions; 16% to full-time lighter jobs.
• Neurologic impairment strongly correlated with work status (P < 0.00005); pain and occupation also impacted outcomes.

Conclusions:

• Neurologic injury significantly impacts functional recovery more than surgical extent or instrumentation.
• Pain-related limitations often stemmed from radicular/neuropathic symptoms, not just back pain.
• Persistent back pain suggested correctable mechanical issues like sagittal imbalance or pseudarthrosis.